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Published on: July 25, 2025
Sagittal spinal alignment in patients with lumbar disc herniation
Kenji Endo1, Hidekazu Suzuki, Hidetoshi Tanaka
1Department of Orthopedic Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. kendo@tokyo-med.ac.jp
Summary
Patients with lumbar disc herniation (LDH) show abnormal sagittal spinal alignment, including increased C7 plumb line distance and reduced lumbar lordosis. This spinal malalignment correlates with lower back pain severity and improves after surgery.
Area of Science:
- Orthopedics
- Radiology
- Spine Surgery
Background:
- Abnormal sagittal spinal alignment is linked to low back pain.
- Previous research on lumbar disc herniation (LDH) has focused on scoliotic list, with limited data on sagittal alignment and subjective symptoms.
- Understanding sagittal alignment in LDH is crucial for assessing pathophysiology and treatment outcomes.
Purpose of the Study:
- To evaluate total sagittal spinal alignment in patients with lumbar disc herniation (LDH) compared to healthy individuals.
- To investigate the relationship between sagittal spinal alignment parameters and subjective low back pain.
- To assess the postoperative changes in sagittal alignment after surgical intervention for LDH.
Main Methods:
- Retrospective cross-sectional study involving 61 LDH patients and 60 healthy controls.
- Lateral whole-spine standing radiographs were analyzed for sagittal vertical axis (SVA), lumbar lordotic angle (L1S1), and pelvic tilt angle (PA).
- Subjective symptoms were assessed using the Japanese Orthopedic Association (JOA) score for lower back pain.
Main Results:
- LDH patients exhibited significantly larger SVA, smaller L1S1, and larger PA compared to controls.
- Postoperative assessment at 6 months showed recovery of malalignment to near control levels.
- SVA demonstrated a significant correlation with subjective symptoms measured by the JOA score.
Conclusions:
- Lumbar disc herniation is associated with anterior C7 plumb line translation, reduced lumbar lordosis, and a more vertical sacrum.
- Sagittal spinal alignment parameters are valuable for assessing LDH pathophysiology.
- Surgical correction of LDH can restore sagittal spinal alignment and improve subjective pain outcomes.
